History of Hoxsey Treatment

by Patricia Ward Spain

The
cancer treatment practiced by Harry M. Hoxsey (1901-1974)
is one of the longest-lived unconventional therapies of this
century. It has retained great popular appeal, despite unrelenting
opposition by the medical profession; despite 40 years of
biting journalistic ridicule by such skilled AMA journalists
as Arthur Cramp and Morris Fishbein; despite an unceasing
stream of court actions; even despite an unprecedented Public
Warning Against Hoxsey Cancer Treatment which the Commissioner
of the FDA ordered mounted in 46,000 US post offices and substations
in 1956 (Young, 1967, 387; Larrick, 1956). Since Hoxseys death,
his treatment has continued under his longtime nurse assistant,
Mildred Nelson, who currently oversees the thriving Bio-Medical
Center at Tijuana, within sight of the border between Mexico
and the United States. (Hoxsey himself chose this site in
1963, when his heart had begun to fail and the combined pressures
of organized medicine and the FDA had finally closed down
his last operation in the US [Chowka, 1984; New York Times,
1955].)

As
Illinois coal miner before he began to promote himself as
a healer in the 20s, the colorful, dynamic Hoxsey mixed his
medicine with flamboyant public statements that skillfully
contrasted his populist heritage with the growing elitism
and hauteur of the American medical profession at mid-twentieth
century (Young, 1967). In common with many advocates of unconventional
therapies, Hoxsey considered cancer a systemic disease, however
localized its manifestations might appear to be. Hence his
therapy aims to restore physiological normalcy to a disturbed
metabolism throughout the body, with emphasis on purgation,
to help carry away wastes from the tumors he believed his
herbal mixtures caused to necrotize (Hoxsey, 1956, 44-48,
60).

Hoxsey
treated external cancers apparently with considerable success,
even in the judgment of his critics with local applications:
sometimes by a red paste containing antimony sulfide, bloodroot
(Sanguinaria canadensis) and zinc chloride; sometimes by a
yellow powder containing arsenic and antimony sulfides, various
plant substances, talc, and what Hoxsey called yellow precipitate
(JAMA, 1951, 253; Hoxsey, 1956, 47). In 1941 Frederick Mohs,
a respected surgeon in Madison, Wisconsin, with the help of
the Dean of the University of Wisconsin Medical School and
several of its faculty, devised a method of surgically removing
accessible cancers under complete microscopic control (Mohs,
1941). The substance which Dr. Mohs and his co-workers created
for fixing the suspected tissue in situ, to enable him to
excise it layer by microscopic layer, contained the same ingredients
as Hoxseys red paste. Dr. Mohs published his new method in
1941 in the ultra-respectable Archives of Surgery and in 1948
in JAMA (for later refinements, see Mohs, 1956; Phelan 1962,
1963a, and 1963b). Nonetheless AMA spokesmen, during their
accelerated onslaught on Hoxsey in the 40s and 50s, discounted
the fact that Mohs paste and Hoxseys were identical. In condemning
caustic pastes as one type of frauds and fables in 1949, the
AMA implied that arsenic was the chief ingredient of Hoxseys
paste, on the basis of their own testing of a sample pirated
in the 20s (JAMA, 1926, 57; Young, 1967, 365). Apparently
Mohs use of surgery (which, along with radiation, constituted
the entire range of what the Council considered established
treatment) made his method, in contrast to Hoxseys, scientific
and acceptable. The Council failed to grasp the central fact
that both men were using sanguinarine, an alkaloid of bloodroot
which has potent antitumor properties described in the medical
literature as early as 1829 (Young, 1967, 365; Hartwell, 1960,
23-24).

The
most controversial aspect of Hoxseys method, in the eyes of
orthodox medicine, was the dark brown liquid which he used
to treat internal cancer. For many years Hoxsey refused to
divulge the formula for this substance, generating a frenzy
of vituperation in the pages of JAMA over a period of decades.
He later gave several differing accounts of its origin (Young,
1967, 362). According to his autobiography (Hoxsey, 1956,
62-64), it was his great-grandfather, a horse breeder named
John Hoxsey, who developed it at mid-nineteenth century, out
of grasses and flowering wild plants which John took from
the pasture where a favorite stallion, afflicted with a cancerous
growth, grazed daily until the growth necrotized. According
to Harry, John Hoxsey reasoned that the wild plants had caused
the stallions recovery. He therefore concocted a liquid out
of red clover and alfalfa, buckthorn and prickly ash (and
other plants which John could not identify), gathered from
the area where the stallion had apparently cured himself.

John
continued adding ingredients from old home remedies for cancer,
until he found an herbal mixture that seemed to help similarly
afflicted horses in the area around his farm, between Carlinville
and Edwardsville, Illinois. According to Harry, Johns reputation
as a man with the ‘healing tetch soon brought him business
from horse breeders all over Illinois and as far away as Kentucky
and Indiana (Hoxsey, 1956, 64).

As
the autobiographical account has it, John Hoxsey bequeathed
the formula to his son, who in turn presented it to Harrys
father, John, a veterinary surgeon licensed under the grandfather
clause of the Illinois Medical Practice Act of 1877. Fired
with the notion that a remedy effective in curing horses might
be of equal benefit to human beings stricken with the same
disease, John Hoxsey began quietly treating cancer patients
under the supervision of two MDs in the region of Girard,
Illinois, where he bought a livery stable shortly after Harrys
birth in 1901. From the age of 8, Harry served as his fathers
trusted assistant, as growing numbers of human patients gradually
crowded out his veterinary practice (Hoxsey, 1956, 66-71).
Recognizing Harrys calling to be a doctor, John gave the family
formulas as a deathbed legacy to Harry in 1919, charging him
to go forth and heal the sick if need be, in defiance of the
High Priests of Medicine (Hoxsey, 1956, 65, 71-74; Young,
1967, 362-363).

Harrys
initial unwillingness to disclose the formula, taken together
with his peripatetic existence (Taylorville, Illinois; Chicago;
Clinton, Iowa; Philadelphia, Detroit; Wheeling; Atlantic City;
Dallas), his growing financial success, and his open taunting
of organized medicine, led Morris Fishbein to label Harry
(and his late father) as charlatans. This assault, entitled
Blood Money and published in 1947 in the Hearst chains widely
circulated magazine section, American Weekly provoked Harry
to sue for libel. He won though the judgment called only for
a token payment for injury to Harrys and his fathers reputations
(Young, 1967, 374-375).

For
all that the AMA and the FDA had been trying to force this
revelation from Hoxsey for more than a quarter-century, they
did not respond to it by investigating these botanical constituents
for possible pharmacological properties. Instead, the AMA
Bureau of Investigation dismissed the entire formula as worthless:
only potassium iodide has any recognized therapeutic activity.
The Bureau added that Any person possessing a modicum of knowledge
of the pharmacological action of drugs should know that any
combination of ingredients listed on the current label of
Hoxsey Tonic…is without any therapeutic merit in the treatment
of cancer. Disregarding the most fundamental question in science
i.e., What is the evidence? the AMA insisted that any intelligent
physician could testify that all of these substances were
worthless in the internal treatment of cancer (JAMA, 1954,
667-668).

A
specialist in pharmacological and experimental therapeutics
from Johns Hopkins testified at the FDA trial that there was
no basis for therapeutic claims for any of the contents, but
he did not publish either laboratory or clinical data to support
this conclusion. A noted cancer research scientist testified
that, in an experiment he had conducted for the FDA (also
apparently unpublished), malignant growths in mice appeared
larger at autopsy than before the mice received the Hoxsey
tonic (Young, 1967, 375-376). The FDA and the NCI merely reviewed
cases. In the public warning issued against Hoxsey in 1956,
Commissioner George P. Larrick stated that the FDA, after
what he called a thorough and long-continuing investigation,
had not found a single verified cure of internal cancer effected
by the Hoxsey treatment. Larricks warning said an NCI review
of case histories submitted by Hoxsey likewise failed to provide
evidence of therapeutic effect (Larrick, 1956).

In
addition to an extensive literature attesting the folk use
of Hoxseys herbal ingredients in the treatment of cancer (Hartwell,
1967 and 1971), the orthodox medical literature at that time
contained at least one suggestive article about one of them,
based on empirical observation by a regular, orthodox practitioner.
In 1896, in the Medical and Surgical Reporter (Philadelphia),
a surgeon described the action of poke root as retarding the
growth of epitheliomas and increasing the patients survival
time, if it was given before ulceration became extensive (Millard,
1896, 421). Despite bibliographic tools that make it easy
to search the medical literature back through the 19th century
and beyond, this article had apparently escaped the attention
of the AMA, the FDA, and the NCI.

More
recent literature leaves no doubt that Hoxseys formula, however
strangely concocted by modern scientific standards, does indeed
contain many plant substances of marked therapeutic activity.
In fact, orthodox scientific research has by now identified
antitumor activity of one sort or another in all but three
of Hoxseys plants and two of these three are purgatives, one
of them (Rhamnus purshiana) containing the anthraquinone glycoside
structure now recognized as predictive of antitumor properties
(Kupchan, 1976).

Between
1964 and 1968 four articles appeared in Lancet, Pediatrics,
and Nature, describing the mitogenic activity of pokeweed,
which triggers the immune system by increasing the number
of lymphocytes, causing the formation of plasma cells, and
elevating levels of immunoglobulin G (Farnes, 1964; Barker,
1965; Barker, 1966; Downing, 1968).

In
1966 two Hungarian scientists, engaged in a screening program
at the University of Szeged, published their findings of considerable
antitumor activity in a purified fraction of burdock, a plant
which they included in their project because of its use as
a folk remedy for new growths and ulcerations (Dombradi, 1966).
In 1972 Kupchan described the growth-inhibiting activity of
sesquiterpene lactones, a structural group which includes
burdock (Kupchan, 1972). In 1984 researchers at Nagoya University,
Japan, found in burdock a new type of desmutagen; a substance
uniquely capable of reducing mutagenicity both in the absence
and in the presence of metabolic activation. So important
is this new property that these scientists named it the B-factor,
for burdock factor (Morita et al., 1984).

Two
recent studies from the Orient, one Japanese, one Chinese,
have established the presence of antitumor substances in barberry
(which Hoxsey also sometimes called berberis root). Testing
tumor size in mice by the total packed cell volume method,
Hoshi and his co-workers found strong antitumor activity in
berberrubine, an alkaloid isolated from Berberis vulgaris
(Hoshi, 1976). Also in 1976, Owen et al. derived from berberine
a new antitumor substance which they have named Lycobetaine
(Owen, 1976).

At
the University of Virginia in the mid-70s, Kupchan and Karim
isolated an antileukemic principle from buckthorn (Rhamnus
frangula). Their discovery that the efficacy of this substance
in leukemia is vehicle-dependent led these scientists to advise
re-testing of other anthraquinone plant substances for similar
antitumor activity (Kupchan, 1976).

The
least studied of Hoxseys herbs to date are stillingia sylvatica
and prickly ash (Zanthoxylum americanum), but even these are
represented in the scholarly literature. In 1980 two German
scientists discovered several new diterpene-esters (a chemical
group known to have antitumor activity) in Stillingia root,
the portion of this plant used by Hoxsey (Adolf, 1980). At
a symposium on folk medicine in 1986, Varro Tyler observed
that, despite the wide use of northern prickly ash bark in
folk medicine, it has been nearly 50 years since any studies
were done of its chemical composition and there have never
been activity-directed fractionation studies. Noting that
pharmacological tests have revealed significant anti-inflammatory
and anesthetic properties in several closely related species,
Tyler urges scientists to study prickly ash for these and
other therapeutic properties (Tyler, 1987, 106).

Whether
there is therapeutic merit in Hoxseys particular formula for
internal use remains as much a question today as it was in
1925, despite provocative findings of antitumor properties
in many of the individual herbs he used. Neither laboratory
nor clinical reports have roused the AMA, the FDA, or the
ACS to re-examine the possibility of efficacy.

In
adding Hoxseys remedy to its Unproven Methods list (ACS, 1971),
the ACS used its customary phraseology about lack of evidence
of worth. In actuality, except for work with mice done in
the 50s by an outside contractor for the NCI, but never published
in the scientific literature, it appears that Hoxseys treatment
has never been tested, either in animals or in humans. The
only negative investigation cited by the ACS was a three-day
visit to Hoxseys clinic by several Canadian physicians, who
failed to find merit in his methods (American Cancer Society;
Moss, 1980).

As
recently as 1965, Morris Fishbein, former long-time editor
of JAMA, repeated in Perspectives in Biology and Medicine
a rolling, melodramatic sentence he had first coined for a
popular presentation of the AMA case against quackery on the
March of Time. In 1947, in a major JAMA editorial called Hoxsey
Cancer Charlatan, Fishbein reiterated this favorite phrase:
Of all the ghouls who feed on the bodies of the dead and the
dying, the cancer quacks are most vicious and most heartless.
Verbiage such as this, widely circulated by the influential
writer who was the Voice of American Medicine for more than
four decades, has done much to set the low level of discourse
and the emotional rather than analytical tone that have characterized
the American medical professions response to unorthodox remedies.

In
1976, surveying the results of the plant screening program
begun in 1960 by the Cancer Chemotherapy National Services
Center at the NCI, Richard Spjut noted that the occurrence
of activity was found to be higher in plants reported in folk
literature than in plants collected at random, suggesting
a correlation between plants used in folklore and those with
anticancer activity (Spjut, 1976, 979). Jonathan Hartwell,
the chemist who long directed this national program of drug
development from plant products, also values folk usage as
a guide to plants likely to yield therapeutically active substances.
In his Plant Remedies for Cancer (1960), Hartwell quoted historian
of science, George Sarton, on the recurrent phenomenon of
initial medical hostility toward folk remedies that eventually
become valued tools in conventional medical usage. Writing
in 1947, Sarton had in mind chaulmoogra (for leprosy), cinchona
bark (for malaria), and variolation (for smallpox): to these
we can now add (for cancer alone) periwinkle, mistletoe (labelled
a promotion by Morris Fishbein as recently as 1965), Mayapple,
autumn crocus, and chaparral tea. Sarton counselled the profession
to exhibit less intellectual arrogance and more open-mindedness:
The remembrance of these astounding folk discoveries should
sober our thoughts when we criticize too freely the old pharmacopoeias.
It is easy to make fun of mediaeval recipes; it is more difficult
and may be wiser to investigate them. Instead of assuming
that the mediaeval pharmacist was a benighted fool, we might
wonder whether there was not sometimes a justification for
his strange procedure. (quoted in Hartwell, 1960, 24).

Farnsworth, Norman R., interview, April 11, 1988. Professor
Farnsworth, of the WHO Collaborating Centre for Traditional
Medicine, is Director of the Program for Collaborative Research
in the Pharmaceutical Sciences at the University of Illinois
at Chicago. He generously shared his knowledge and his comprehensive
files of the international literature of botanical medicine
and medicinal chemistry. His assistance was central to this
report.

Kupchan, S. Morris, Recent Advances in the Chemistry of
Tumor Inhibitors of Plant Origin, Swain, Tony (ed.), Plants
in the Development of Modern Medicine (Cambridge, MA, and
London: Harvard University Press, 1972), pp. 261-278.

Tyler, Varro E., Some Potentially Useful Drugs Identified
in a Study of Indiana Folk Medicine, Scarborough, John (ed.),
Folklore and Folk Medicines (Madison, WI: American Institute
of the History of Pharmacy, 1987).

Young, James Harvey, The Medical Messiahs: A Social History
of Health Quackery in Twentieth-Century America (Princeton,
NJ: Princeton University Press, 1967).